Key points The very-low-birth-weight infant is hemodynamically vulnerable due to a unique set of risk factors, which include an immature myocardium with poor response to volume load and afterload, immature autonomic vasoregulation, and thus ineffective cardiovascular compensatory mechanisms, a propensity…
Key points The simplistic “treat all or treat none” approach to management of a patent ductus arteriosus (PDA) has been increasingly challenged in recent years as the variation in clinical and hemodynamic presentation has been realized. Spontaneous closure rates, poor…
Key points Percutaneous (or transcatheter) PDA closure is an emerging technique that has gained popularity in the most recent years and is being performed in progressively smaller and younger patients. Advancements in the technique, the launch of devices that are…
Key points The pharmacological management of PDA in the very preterm neonate remains a controversial topic, as the risks and benefits of the pharmacotherapeutic options remain unclear. NSAIDs (indomethacin and ibuprofen) and acetaminophen are the most common and effective pharmacological…
Key points Although presence of a patent ductus arteriosus (PDA) can easily be confirmed with echocardiography, diagnosis of a hemodynamically significant PDA is more challenging and not standardized. Evaluation of hemodynamic and clinical significance of a PDA should include assessment…
Key points The status of cerebral oxygenation is not always represented appropriately by systemic arterial oxygenation, especially when there are changes in cerebral blood flow or cardiac output. Oxygenation monitoring of the brain by near-infrared spectroscopy (NIRS) is therefore an…
Key points Accurate assessment of the hemodynamic status in critically ill neonates requires blood pressure measurements to be interpreted in the context of indirect (clinical signs) and direct (measurements and assessments) indicators of systemic circulation (cardiac output) and regional organ…
Key points Cardiac magnetic resonance (CMR) Imaging techniques provide noninvasive assessments of the newborn circulation with high accuracy and repeatability. Cine CMR produces three-dimensional assessments of chamber volumes and myocardial mass. Phase contrast CMR can quantify blood flow in any…
Key points Cardiac output monitoring in preterm and term neonates is feasible but remains challenging despite the availability of different technologies. The best systems to monitor cardiac output in the clinical setting in neonatal intensive care at present are transthoracic…
Key points Tissue Doppler imaging (TDI) is a modality that employs the Doppler effect to assess muscle wall characteristics throughout the cardiac cycles including velocity, displacement, deformation, and event timings. Two-dimensional speckle tracking echocardiography (2DSTE) is a non-Doppler technique that…